- Improve member care, service, experience, access and/or safety; and/or
- Improve service to practitioners, providers, employers, brokers and other customers and partners; and/or
- Improve Medica's internal operations related to care, service, experience, access and patient safety.
The QI program supports Medica's mission to be the trusted health plan of choice for customers, members, partners and our employees.
Our QI program covers a wide range of topics that affect our members, providers, employers and brokers, as well as our internal staff. We want to be sure that:
- Our members receive high-quality health care and service from our providers.
- Our members can get appointments quickly. We have enough doctors in the areas where our members live.
- Our members get the help they need when they change doctors.
- Our complaint and appeal processes work fairly and efficiently.
- We can offer appropriate help to our members with chronic health problems.
- We can help our members be sure that the care they receive is safe.
- Our members are satisfied with Medica, and we're identifying areas where we can do better.
To create an effective quality plan, Medica must understand what our customers need, want and believe about health care. We learn about members and other important stakeholders through satisfaction surveys, reports on member complaints and appeals, focus groups, market research and other data that shows the kind of care our members receive and how well it works for them.
When Medica chooses QI projects, we look for the best opportunities to improve care, service and safety for the greatest number of members. These are some of the questions we consider:
- Will this improvement be meaningful to our members?
- Do we have the ability to make a real impact on the problem?
- How are we doing compared to other local and national health plans? Can we do even better?
- What laws and regulations do we need to consider?
- What will it cost – in dollars, time, and staff – to do this project well?
Once we choose a project, we set a performance goal. We measure progress toward the goal throughout the project to see how effective the improvement is.
Every year, Medica prepares a Quality Improvement Work Plan. The work plan is a summary of the key QI activities we plan for the year. Here are some examples of projects on the current work plan:
Every work plan activity has an "owner" — a Medica staff member who watches over the project and reports on progress. Some projects or goals may change during the year if progress reports show we aren't getting the results we need. We may also add new projects throughout the year.
Medica evaluates the QI program at the end of each year. The Quality Improvement Program Evaluation is a report that reviews how well we did on our quality improvement activities. In the report, we compare measurements and look for trends to see how well we've done over time. If we didn't meet a goal, we also report on any problems or unexpected happenings that kept us from being successful.
The QI Program Evaluation is an important learning tool for Medica. The information in the report helps us understand how effective our QI program has been, and also helps us make recommendations for the next year's work plan.
At Medica, quality is everyone's responsibility. Departments and staff throughout Medica "own" and participate in QI activities. The Senior Medical Director, a licensed physician, is responsible for leading the QI program. Staff in the Quality Improvement department monitor and support program activities.
Medica's Quality Improvement Subcommittee (QIS) directs and oversees the QI program. QIS is staffed by Medica employees representing key business units across the organization. QIS reports to the Medical Committee of the Medica Board of Directors. The Medical Committee then reports to the full Medica Board of Directors.
Medicaid Quality Improvement Program
Medica has Quality Improvement (QI) activities focused on improving health outcomes for our Medicaid members. We offer Medicaid plans across Minnesota for all ages and abilities. They include:
- Plans for people age 65 and older: Minnesota Senior Health Options (MSHO) and Minnesota Senior Care Plus (MSC+)
- Plans for people age 18-64 with disabilities: (Special Needs BasicCare (SNBC) and Special Needs BasicCare with Medicare (Integrated SNBC or ISNBC)
- Plans for people age 0-64:Prepaid Medical Assistance (PMAP) and MinnesotaCare (MNCare).
We understand that the needs of our Medicaid members vary. That is why each year we identify QI activities aimed to improve the health of our members. Current focus areas include:
- Reducing disparities in health outcomes. This includes special focus on diabetes care and care for pregnant members, infants and children
- Improving member satisfaction
- Improving oral health outcomes and access to dental care
Examples of QI activities in these focus areas include:
- Medica is working with other Minnesota Health Plans on a 3 year Performance Improvement Project (PIP). The project aims to improve diabetes care and decrease the disparity in blood pressure rates between Black, Indigenous, and People of Color (BIPOC) members and non- Hispanic White members.
- The PIP runs from 1/1/21 through 12/31/23. The project is focused on members enrolled in our MSHO, MSC+ and SNBC products.
- To measure the success of the PIP, we are using a measure that looks at the percentage of members with diabetes whose blood pressure is considered well-controlled (<140/90 mm Hg).
- When we measured the disparity in blood pressure control before starting the project, we found a disparity of 7.45%. BIPOC members were less likely to have well-controlled blood pressure compared to non- Hispanic White members.
- Our goal is to decrease that disparity to 2.60% over the course of the project.
- So far, we are making good progress toward our goal, as shown in the graph below.
- Lessons Learned: While we are making progress toward our goal, disparities remain in certain populations. Also, members don't always know about the benefits and incentives available to them that could help them manage their diabetes better.
- Next Steps: Medica is working with members and providers on ways to improve diabetes health and address the social and environmental factors that impact health. This includes providing targeted education to Care Coordinators so they have information to help members manage their diabetes. In addition, our pharmacy team and Disease Management Nurses continue to outreach to members to provide education and address barriers members may be experiencing. Medica also continues to offer several benefits and incentives to support members with their diabetes care and management, including gym memberships, nutrition programs, foot care, and others. We aim to increase the use of these benefits and incentives by providing more education to both members and their Care Coordinators.
- Visit here for helpful resources on diabetes: Diabetes - MyHealthfinder | health.gov
- Medica started a "Healthy Start" Performance Improvement Project (PIP) in 2022 together with other Minnesota Health Plans.
- The goal of this PIP is to promote a "Healthy Start" for children in our PMAP and MNCare populations. We want to do this by improving outcomes and reducing disparities in prenatal, postpartum and well-child care.
- As data is available for Medica's new PMAP and MNCare members, Medica will set project goals and measure our success in improving care and reducing disparities.
- Lessons Learned: Medica offers a lot of resources to help members with their pregnancy and well-child care but members don't always know about them.
- Next Steps: We will continue to engage members through our Pregnancy Program. The program offers members multiple resources with the goal of helping them get on the path to a healthy pregnancy. We also are working on ongoing member education about the benefits and incentives Medica offers to help members say on track with their prenatal, postpartum and well-child care. We want to make sure members understand and get the most out of all the resources available to them
- Visit here to learn about Medica's Pregnancy Program:
Medica Prenatal and Postpartum Services
- Each year, Medica sends surveys to a sample of MSHO, MSC+, ISNBC and SNBC members. The survey measures member satisfaction with Medica's Care Coordination program.
- Medica works hard to make the survey more accessible to members. In 2022, we provided the survey in English, Russian and Spanish. In 2023, Medica plans to expand the survey to include Hmong, Somali and Vietnamese.
- Lessons Learned: We learned from these surveys that overall, our members are very satisfied with the Medica Care Coordination Program and the services they get from their Care Coordinators. In 2022, Medica also surveyed Care Coordinators and Customer Service staff who work with our members. We learned Care Coordinators and Customer Service Staff could use more resources to help them better serve Medica members.
- Next Steps: We are working on improving tools, resources and training for Care Coordinators and Customer Service Staff.
- We understand that oral health is an important part of overall health. Taking care of your mouth and teeth can help prevent both dental and medical problems. For this reason, Medica has made improving the oral health of our members a top priority.
- Each year, we take steps to increase the number of members who visit the dentist. Our goal is to achieve a minimum annual dental visit rate of 55% for our PMAP and MNCare membership and 80% for our Seniors and SNBC membership.
- In 2022, Medica started a Dental Workgroup whose purpose and mission is to increase dental visits and improve dental rates for our Medicaid members.
- Lessons Learned: When we engaged with Community Health Centers and Critical Access Dental providers, we gained a better understanding of the barriers that providers and our members experience in accessing dental services.
- Next Steps: To keep making progress we are taking steps to remove those barriers and make dental care accessible and equitable for all. These steps include:
- Removing the 30/60 mile transportation rule for dental appointments
- Increasing member incentives for completing an annual dental visit
- Meeting with care systems to share dental results and discuss opportunities for improvement
- Reaching out to members who are overdue for dental visits
- Providing dental resources at community engagement events
- Training and education for care coordinators
- As a result of these efforts, we are seeing improvement in our annual dental visit results each year.
Finding quality health care for yourself or your loved ones is often a primary — and sometimes puzzling — concern. We want to connect you with the information you need to make sound health care choices for yourself and your family.
Below you will find a variety of resources you can use to research the quality of care provided by physicians, primary care clinics and hospitals.
HealthGrades National Health Index: This site provides accessible and transparent information on physicians and hospitals as well as helps users connect with their provider of choice.
NCQA Health Care Report Card by Practice: These reports examine how well doctors, other clinicians, practices, health insurance plans and other health care organizations nationwide perform. The report cards are a compilation of all NCQA accreditation, recognition, certification and distinction programs.
Administrators in Medicine (AIM) DocFinder: This online physician directory contains licensing and disciplinary information of health care practitioners by state.
MN Community Measurement (MNCM): MNCM develops measures, collects data and creates reports that drive improvement in health care. Its mission is to accelerate health care improvement by public information reporting.
The Leapfrog Group: This national nonprofit collects and transparently reports and compares hospital performance based on their quality of care, giving consumers the information they need to make informed decisions.
MN Department of Health Adverse Events Search: Area hospitals are required to report to the MN Department of Health whenever any of 28 identified preventable adverse events occur.
Minnesota Hospital Quality Report: This site gives you a snapshot of hospital performance in five key areas (heart attack, heart failure, pneumonia, infection prevention and surgical care), along with patient ratings.
Quality Check: This site lets you see whether a health care organization has been accredited or certified by the Joint Commission.
Patient safety means focusing on reducing and eliminating accidental or preventable injuries from medical care. While Medica doesn't provide direct medical care, we can still help our providers and members reduce medical errors and keep health care safe and effective.
Medical errors are more common than many people realize. A government report published by the Institute of Medicine in 2000 found that between 44,000 and 98,000 people die each year because of medical errors in hospitals. Accidents — and near-misses — can also happen in clinics, pharmacies and other care facilities, and even at home, when patients take medicine and follow treatment orders on their own.
Information is probably the single best patient safety tool. When you talk to your doctor, your surgeon, your pharmacist or any other care provider, it's very important to ask questions and make sure you understand the answers. The Agency for Healthcare Research and Quality (AHRQ) has some helpful fact sheets to get you started (these links will take you outside the Medica site).
Medica takes part in many programs that support patient safety.
- Our Quality Resources section provides easy-to-use quality comparisons among primary care clinic systems and hospitals in the Medica network.
- Our nurses visit primary care clinics as part of our Quality Review programs. The quality review includes checks for safety features such as safe medicine storage and emergency medical equipment kept in good working order.